Provider Demographics
NPI:1033857099
Name:HENRY, KRISTINA MARIE
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 CR 4602
Mailing Address - Street 2:
Mailing Address - City:BENWHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:75754
Mailing Address - Country:US
Mailing Address - Phone:903-570-9135
Mailing Address - Fax:
Practice Address - Street 1:2272 CR 4602
Practice Address - Street 2:
Practice Address - City:BENWHEELER
Practice Address - State:TX
Practice Address - Zip Code:75754
Practice Address - Country:US
Practice Address - Phone:903-570-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81328101YP2500X, 101YM0800X
TX101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool